A study of mortality and morbidity profile of electrolyte imbalance in critically ill children with special importance to mechanical ventilation


  • Kishore S. V. Department of Pediatrics, SVPPGIP, SCB MCH, Cuttack, Odisha, India
  • Mrutyunjay Routray Department of Pediatrics, AIIMS, Bhuvneshwar, Odisha, India
  • Jyotiranjan Champatiray Department of Pediatrics, SVPPGIP, SCB MCH, Cuttack, Odisha, India
  • Saroj Kumar Satpathy Department of Pediatrics, SVPPGIP, SCB MCH, Cuttack, Odisha, India




Electrolyte imbalance, Mortality, Mechanical ventilation, Pediatric intensive care


Background: Electrolytes imbalance is not uncommon in critically ill children. The outcome of critically ill child is dependent on various factors like the underlying disease, fluid and nutrition, which are responsible for electrolyte homeostasis in tandem with renal function and many others. In this study authors look into morbidity and mortality associated with dyselectrolytemia with special importance to children on mechanical ventilation.

Methods: This prospective observational study was conducted in the PICU, SVPPGIP (SCB MC and Hospital), Cuttack during the period November 2015 to October 2017. Includes children admitted to PICU (Based on consensus guidelines for PICUs in India, Indian Society of Critical Care Medicine (Pediatric Section) and Indian Academy of Pediatrics (Intensive Care Chapter).

Results: Mortality distribution in electrolyte abnormality patients is 27.9% (around 3 times higher than normal electrolyte patients). 25% hyponatremic patients and 31.25% hypernatremia patients expired, 30.76% hypokalemia patients, 32.72% hyperkalemia patients expired. Morbidity distribution in electrolyte imbalance population was 85.27%, with more than 7 days of stay in PICU. Amongst the mechanical ventilated patient, 54.23% patients having potassium disturbances were associated with significant mortality and morbidity. No such significant relation exists between mechanical ventilation and dyselectrolytemia of sodium and calcium.

Conclusions: Early recognition with a thorough understanding of common electrolyte abnormalities and their prompt management definitely pose an implication on the final outcome of the patient. Aggressive and strict adherence to correction of in particular to potassium before weaning is necessary for successful weaning from ventilator.


Conley SB. Hypernatremia. Pediatr Clin North Am. 1990;37:365-72.

Greenbaum LA. Fluid and Electrolyte Disorders. In: Kleigman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson textbook of pediatrics. 1st South Asia ed. New Delhi: Elsevier;2016:346-347.

Stelfox HT, Ahmed SB, Khandwala F, Zygun D, Shahpori R, Laupland K. The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units. Crit Care. 2008 Dec;12(6):R162.

Funk GC, Lindner G, Druml W, Metnitz B, Schwarz C, Bauer P, et al. Incidence and prognosis of dysnatremias present on ICU admission. Inten Care Med. 2010 Feb 1;36(2):304-11.

Buckley C, Oger J, Clover L, Tüzün E, Carpenter K, Jackson M, et al. Potassium channel antibodies in two patients with reversible limbic encephalitis. Annals Neurol: Official J Am Neurol Assoc Child Neurol Soc. 2001 Jul;50(1):73-8.

Blumberg A, Weidmann P, Shaw S, Gnädinger M. Effect of various therapeutic approaches on plasma potassium and major regulating factors in terminal renal failure. Am J Med. 1988 Oct 1;85(4):507-12.

Dooley J, Fegley A. Laboratory monitoring of mechanical ventilation. Critical Care Clini. 2007 Apr 1;23(2):135-48.

Lo SF. Laboratory Medicine. In: Kleigman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson textbook of pediatrics. 1st South Asia ed. New Delhi: Elsevier;2016:3466-3467.

Khilnani P, Indian Society of Critical Care Medicine (Pediatric Section. Consensus guidelines for pediatric intensive care units in India. Ind Pediatr. 2002 Jan;39(1):43.

Subba RS, Thomas B. Electrolyte abnormalities in children admitted to pediatric intensive care unit. Ind Pediatr. 2000 Dec;37(12):1348-53.

Chary DC, Shalini B. Correlation between serum electrolytes and clinical outcome in children admitted to PICU. IOSR J Dent Medica Sci 16. 2017;11:24-7.

Jain M, Shah A, Prajapati R. Study of electrolyte imbalance in critically ill children. Int J Int Res. 2015;2(2):56-9.

Singhi S, Prasad SV, Chugh KS. Hyponatremia in sick children: a marker of serious illness. Age. 1994 Jan;125:126-30.

Singhi S, Gulati S, Prasad SV. Frequency and significance of potassium disturbances in sick children. Ind Pediatr. 1994 Apr 1;31(4):460-3.

Hessels L, Hoekstra M, Mijzen LJ, Vogelzang M, Dieperink W, Lansink AO, et al. The relationship between serum potassium, potassium variability and in-hospital mortality in critically ill patients and a before-after analysis on the impact of computer-assisted potassium control. Crit Care. 2015 Dec;19(1):4.

Singhi S, Murudkar A. Hypokalemia in a pediatric intensive care unit. Ind Pediatr. 1996;33:9-14.

McMahon GM, Mendu ML, Gibbons FK, Christopher KB. Association between hyperkalemia at critical care initiation and mortality. Int Care Med. 2012 Nov 1;38(11):1834-42.






Original Research Articles